round sheet 12-30-13 to 01-05-14 · 2018-07-30 · facility site operations and infrastructure...

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Facility Site Operations and Infrastructure Seismic I Substation #7 I Duct I Fans Round Sheet Location: DAY SUN MON TUES WED BLDG. 413A, AREA SUB #7, & SHIFT 2 1 2 1 a. 1 41-B-700 A & B & C REVIEWER FOT C/0 ITEM MIN NORM MAX (413A) SEISMIC PANEL 413A-5MP-004-001 413A-SMP-004-001 I POWER ON ON (B] / / AREA SUBSTATION #7 AND TRANSFORMER __ ./· NO ABNORMAL CONDITIONS [A] SAT [B] V' ./ -.../ v _/" / XFMR LIQUID LEVEL LOW SAT [B] HIGH v / XFMR PRESS (kPa) -2 .5 7.5 /) XFMRWINDING HIGH TEMP ('C) RESET MONDAY 105' !Z) 50 XFMR LIQUID HIGH TEMP ('C) RESET MONDAY 105' .d 5'1 UVFS DUCTWORK (NEAR BYPASS DAMPERS) ·-'- UVFS CONDENSATE CONTAINER LEVEL [B] [C] 80% ,/ / / / / / UVFS VENTILATION FAN OIL LEVELS 700A BRG OIL LEVELS LOW [B] HIGH v" / v> / 7008 BRG OIL LEVELS LOW [B] HIGH / / ../ // 700C BRG OIL LEVELS LOW [B] HIGH / / ./ / NOTES: [A] • THE PRESENCE OF LEAKS, UNUSUAL ODORS, OR NOISES CONSTITUTES AN ABNORMAL CONDITION. [B) - IF NORMAL CONDITION EXISTS, ENTER A CHECK MARK; OTHERWISE NOTE EXISTING CONDITION. [C) - WHEN CONTAINER IS 80% FULL, SUBMIT REQUEST FOR DISPOSAL (RFD) COMMENTS: EA04AD3008-4-0 Rev. 2 THURS FRI ..... 2 1 ,2 1 Original Signatures on File ..,..., / / ./ ·- r-- -- / ,/ /1 / / / / , / ./ / APPROVED FOR USE/DATE: Date: b?/.it>/..:? -I /.!:1 // SAT 1 I st1N v 2 1 2 .J_ 2 , / / . / ./ v' i;/ v / v ;/ v / / .// <- ,// / / v Original Signatures on File March 5, 2013 Page 1 of 1

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Page 1: Round Sheet 12-30-13 to 01-05-14 · 2018-07-30 · Facility Site Operations and Infrastructure Seismic I Substation #7 I Duct I Fans Round Sheet Location: DAY SUN MON TUES WED BLDG

Facility Site Operations and Infrastructure Seismic I Substation #7 I Duct I Fans Round Sheet

Location: DAY SUN MON TUES WED

BLDG. 413A, AREA SUB #7, & SHIFT 2 1 2 1 a. 1

41-B-700 A & B & C REVIEWER

FOT C/0

ITEM MIN NORM MAX

(413A) SEISMIC PANEL 413A-5MP-004-001

413A-SMP-004-001 I POWER ON ON (B] / / AREA SUBSTATION #7 AND TRANSFORMER __ ./·

NO ABNORMAL CONDITIONS [A] SAT [B] V' ./ -.../ v _/" / XFMR LIQUID LEVEL LOW SAT [B] HIGH v / XFMR PRESS (kPa) -2.5 7.5 /) .¢ XFMRWINDING HIGH TEMP ('C) RESET MONDAY 105' !Z) 50 XFMR LIQUID HIGH TEMP ('C) RESET MONDAY 105' .d 5'1

UVFS DUCTWORK (NEAR BYPASS DAMPERS) .· ·-'-

UVFS CONDENSATE CONTAINER LEVEL [B] [C] 80% ,/ / / / / / UVFS VENTILATION FAN OIL LEVELS

700A BRG OIL LEVELS LOW [B] HIGH v" / v> / 7008 BRG OIL LEVELS LOW [B] HIGH / / ../ //

700C BRG OIL LEVELS LOW [B] HIGH / / ./ / NOTES: [A] • THE PRESENCE OF LEAKS, UNUSUAL ODORS, OR NOISES CONSTITUTES AN ABNORMAL CONDITION.

[B) - IF NORMAL CONDITION EXISTS, ENTER A CHECK MARK; OTHERWISE NOTE EXISTING CONDITION.

[C) - WHEN CONTAINER IS 80% FULL, SUBMIT REQUEST FOR DISPOSAL (RFD)

COMMENTS:

EA04AD3008-4-0 Rev. 2

THURS FRI

..... 2 1 ,2 1 Original Signatures on File

..,..., / / ./

·-r--

--/ ,/ /1 /

/ / / , / ./ /

APPROVED FOR USE/DATE:

Date: b?/.it>/..:? -I /.!:1 // SAT

1 I st1N v

2 1 2 .J_ 2

,

/ / . / ./ v' i;/ v

/

v ;/ v / /

.// ~,. <-,//

/ • / v

Original Signatures on File

March 5, 2013 Page 1 of 1

Page 2: Round Sheet 12-30-13 to 01-05-14 · 2018-07-30 · Facility Site Operations and Infrastructure Seismic I Substation #7 I Duct I Fans Round Sheet Location: DAY SUN MON TUES WED BLDG

Facility Site Operations and Infrastructure V entilation Fans Round Sheet DATE:~ ~i't>)_~- I /.s-IJ~ Location: DAY SUN MON TUES WED THURS FRI SAT

1 f SUN I

413, EXHAUST FILTER BLDG. SHIFT 2 1 2 1 ,...., 2 1 2 1 I/\ 2 1 2 1 2 1 2

UVFS FANS REVIEWER Original Signatures on File

FOT C/0

ITEM MIN NORM I MAX v iJV

413-CP-056-01

CONTROL PANEL 860 FANS (A] SAT J .rf2. CD d) @ (i) ICl3 (fl ro [8]

413-CP-307 -01 B

CONTROL PANEL 700 FANS [A] SAT I aJ @) (i) @ @ G) Q ·~ [81

413-CP-056-01C -860A U/G FILTRATION FAN (KSCFM) [D) [C] [D] I [D) 11~t ~1.>'i .Shhy 5fY¥1 Sli::/1 'Jtrb Yl ~ fPI <~ mYI J''tn y ~~'( ~SIBYl f7By :::~h, \-rf?~

413-CP-056-01 D ( J 8608 U/G FILTRATION FAN (KSCFM) [D) rCJ [DJ I [D) _gtc 'Si'I .Sec.. I~ ~~C. <ec. L£t' ~4 ~...L- S<?c.. _{~1 ~~ 5-ec -~.n.:t. SE:.L.

413-CP-056-01 E r,

860C U/G FILTRATION FAN (KSCFM) [D) rCJ roJ I [D) jf4 SeC ScL- ~--G '56'-- ~e L. ~f-1/ ~'""(__ ~ $pL_ :;~a ... ~ ).IJC De"" Sf.<-413-CP-307-01J - A .~ --- ..--. ..,.,... .il -~ ,4":'\ --=----.. - .< ~ -'="'· ......-.· . D

700A U/G VENTILATION FAN (KSCFM) [OJ [D] I [D) -o C#1 o·t.ZfoQIYii>'ia~l<ti '~Olt?1 trJJ ~O~oCVXO~/)Wl O)t([<J-/ 1\D~ 413-CP-307 -01 K - 7 __,-_,.,.- ,.

_: ~ 1.1 .~ ..... .

.-.t>:'Z\ ... ____... ~

~ A

7008 U/G VENTILATION FAN (KSCFM) [0] [D] I [D) -m92¥1~&Ui ·ft.t:tLHYrt..-r~ 7"'~05f /filf~Jr 11./i!if'lt\i~I'T,41j ~~~<.-~' ITA.G-~if-101-k ... C:.:f- 7Y\b~ ~ 413-CP-307 -01 H

J ,

./'"::" ... -- -:..~l.. """ /' '"' - ' ""' ,c- ::... -~

700C U/G VENTILATION FAN (KSCFM) [OJ {D] I {D) b/9(~·122.&11tL irurr rf>)~ ~ 6C31' <!5~ff'f)~ {'6 L ·OI~O~l:;;J \.:>(2;1]\.illJ.Jtj:S{~ ol3-fh I ') :;(1_ D.~ NOTES: [A]- CHECK THAT THE AUDIBLE ALARM SOUNDS AND THE ALARM LIGHTS ILLUMIN'AT"E. [B] -IF NORMAL CONrnTION~XIST, ENTER A CHECK MARK; OTHERWiSE . NOTE EXISTING CONDITION. [C] - FLOW READINGS TAKEN AT STA. B), (NOTE: EFB HVAC FLOW INCLUDED IN STA. BREADING). [D) - VENTILATION MODES (chart below)

NORMAL MODE (flow per fan 1/S) - MIN= 202 NORM = 212

ALTERNATE MODE (flow per fan 1/S) • MIN= 247 NORM= 260

MINIMUM MODE (flow per fan 1/S) - MIN= 57 NORM = 60

REDUCED MODE (flow per fan liS) - MIN= 57 NORM =60

FILTRATION MODE (flow per fan 1/S)- MIN= 57 NORM =160

COMMENTS:;/) A/A~ tlJ.S{ ~:#'B~1Sg,3j (;}) /fi};IH;t trJS (lfte~!!O 7.sa4) -

EA04AD3008-7-0 Rev. 1

MAX= 223 MBP MODE w/1-860/1-700 FANS (combined flow of all fans 1/S) -MIN= 200 MAX=275

MAX= 273 MBP MODE w/1-860/2-700 FANS (combined flow of all fans 1/S) - MIN= 395 MAX= 425

MAX=63 MBP MODE w/2-860/1-700 FANS (combined flow of all fans 1/S) -MIN= 200 MAX=275

MAX=63 MBP MODE w/ 2-860/2-700 FANS (combined flow of all fans 1/S) - MIN = 395 MAX =426

MAX= 6~ , /l "'\ /". A

( j) &.L~~I- SIGC" (!It :It II I P£7 J {_~ ~ (/~/ ~/IJ c~ LJJ~P ~~t~llj;;-t.)¥sJ APPROVED FOR USEifDATE: Original Signatures on File

-

-

March 5. 2013 Page 1 of 1

Page 3: Round Sheet 12-30-13 to 01-05-14 · 2018-07-30 · Facility Site Operations and Infrastructure Seismic I Substation #7 I Duct I Fans Round Sheet Location: DAY SUN MON TUES WED BLDG

Facility Site Operations and Infrastructure Bldg 458 I 456 Round Sheet

Location: DAY SUN MON TUES WED THURS FRI SAT SUN

458, GUARD & SECURITY BUILDING SHIFT 2 1 2 1 1\ 2 1 /f 1 (\ 2 1 2 1 2 1 2

456, PUMPHOUSE BUILDING REVIEWER Original Signatures on File

FOT C/0 '

ITEM MIN NORM MAX v \ v r

458, GUARD & SECURITY BUILDING

412 ODOR ABS MOD FILTER (PDI-07) 0.5 IS .TtY .fr6'1 412 ODOR ABS CHAR FILTER (PDI-08) 0.5 --:J 412 ODOR ASS MOD FILTER (PDI-09) 0.5 f)')__

403 AHU LOW FILTER (PDI-03) 0.5 ~ 2.0 403 AHU MOO FILTER (PDI-04) 0.5 ,:; .kr;;Y

456-CP-010-01 CONTROL PANEL

DOMESTIC WATER PRESS (PIC-01) 60 65 70 /:{, ~&, bh l<., bP & v ~Drr c)~ '(. 0t., ! ()In (p& b~ b-5 lo5' 456-FIY-010·001 WATER F.LOW METER "-

RAW WATER GALLONS RESET MONDAY [A] I.;L()fj "i! bl02-~ DOMESTIC WATER GALLONS RESET MONDAY [A] I!!'I!J3 r6'67Cf~ .------.\

-~~~--

456-FM-045-001 SEWAGE FLOW METER ,- ........._ """ "'-' -~ '.; f.,-A)" ~ li)

SEWAGE FLOW GALLONS [B] 23,000 (. ~~ ~&JCO -} tw9w 1

-' ,1MblJUA 1-/ -~zra,o] (I f<,(,tJJ~· j /JjoD" I 1-:JotJ HACH TEST KIT

~ .. '-- ·-..!. _..,.-L

COLORIMETER FREE CL2 (PPM) 0.7 [C] 1.2 /,//. /.J 3 , _ ;O ~¥? '~(. .'15 • 'f/ ;i{)

NOTES: [A] - RESET METER AFTER TAKING THE READING ON MONDAY SECOND SHIFT

[B] . REQUIRED FOR COMPLIANCE WITH NMED DISCHARGE PERMIT DP-831 --IF MAX LIMIT OF 23,000 GPO IS EXCEEDED CONTACT FSM

[C] - ADJUST CHLORINE LEV,!iLS BY EITHER ADDING WATER (CHLORINE ABOVE 1.2) OR ADDING CHLORINE (CHLORINE BELOW . 7) TO MAINTAIN SPECIFICATIONS

COMMENTS:(!) {5/11 /'J&hVv

EA04AD3008-11-0 Rev. 2

I

APPROVED FOR USE/DATE:

A Original Signatures on File

June 17, 2013 Page 1 of 1

Page 4: Round Sheet 12-30-13 to 01-05-14 · 2018-07-30 · Facility Site Operations and Infrastructure Seismic I Substation #7 I Duct I Fans Round Sheet Location: DAY SUN MON TUES WED BLDG

Facility Site Operations and Infrastructure Domestic I Fire W ater Round Sheet RCRA/TSR

Location: DAY SUN MON TUES WED THURS FRI SAT SUN

SHIFT 2 1 2 1 f'\2 1 2 1 2 1 2 1 2 1 2 0.

456, PUMPHOUSE BUILDING REVIEWER Original Signatures on File

FOT CIO

ITEM MIN NORM MAX v >:" v

DOMESTIC WATER STORAGE TANKS

01A SOUTH WATER STG TNK LVL Ll-01 80% [D) 1& ~~ Cfi> ~~ 9~ Clll 41 ~1 q~ cr~ ~/) q~ q; Cf1 7'(;; ( 456-L T -006-001) fSR 4.1.1.91

01A VISUAL INSPECTION [A] SAT{B][C] V' / / ~ ~ .....- /' ,_// / / V"' v v- I t/ 018 NORTH WATER STG TNK LVL Ll-02

60% 18 ~tf 9t.f ') O 8'1' fli I 00 cyJ ~1 ~4 <=t3 _1:;2.. ~0 ?:,~ ?>Lf (456-LT-006-002)

018 VISUAL INSPECTION [A] SAT[B][C] v y / v' __.... / / ./ / v v / ~/'""' / v TIME OF INSPECTION t1J2JD \'152.- 0<!5tJ Jt..;3U 110e'LJC I~W D1V( 1-ff(} aqzz. Q.~O~ 01/lf (!) <!oj 10 lJ D 1450 NOTES: [A] -IF NORMAL CONDITIONS EXIST, AND THE INSPECTION IS SATISFACTORY, ENTER A CHECK MARK; OTHERWISE NOTE EXISTING CONDITION.

[B) -INSPECT FOR LEAKS, VISIBLE CORROSION, INSULATION INTACT, ETC. [C)- WHEN A NOTED CONDITION IS CORRECTED, ENTER THE DATE AND NATURE OF REPAIRS; OR OTHER REMEDIAL ACTION TAKEN THAT CORRECTED THE CONDITION.

[D) - LCO REQUIREMENT: LEVEL IN FIRE WATER TANK MUST BE~ 105,000 GALLONS (65%). 1F NOT IMMEDIATELY NOTIFY FSM. COMPLETE THE SURVEILLANCE DATA SHEET FOR LCO

3.1 .1, SURVEILLANCE REQUIREMENT 4.1 .1.9, FORWARD THE COMPLETED SURVEILLANCE DATA SHEET TO THE FSM.

'COMMENTS: (STATE AR NUMBER SUBMITTED TO CORRECT ABNORMAL CONDITION IFIWHEN KNOWN)

OPERATORS INITIALING THIS LOGSHEET SHALL COMPLETE THE FOLLOWING:

-

EA04AD3008-12·0 Rev. 1

NAME (PRINT) INITIALS ~E (PRINT)

Original Signatures on File

-APPROVED FOR USE/DATE:

INITIALS NAME (PRINT)

/l Original Signatures on File

INITIALS

March 6, 2013 Page 1 of 1

-

Page 5: Round Sheet 12-30-13 to 01-05-14 · 2018-07-30 · Facility Site Operations and Infrastructure Seismic I Substation #7 I Duct I Fans Round Sheet Location: DAY SUN MON TUES WED BLDG

Facility Site Operations and Infrastructure Support Bldg Substation I UPS Round Sheet RCRA

Locat ion : DAY SUN MON TUES WED

SHIFT 2 1 2 1 2 1

451, ELEC. EQUIP. RM. 116 REVIEWER CMR

FOT C/0 - -ITEM MIN NORM MAX v

45P-SWG04/1 SUPPORT BUILDING SUBSTATION """ /.

NO ABNORMAL CONDITIONS [A] SAT [B] 7 / / / _,..,. .._/

TR-15/1 XFMR HIGH TEMP ('C) RESET MONDAY 170' -;:,o lho 45P-UPS03/2 SUPPORT BUILDING UPS

NORMAL OPERATION LOAD ON UPS [B] 7 7 ... 7 ,/ _ / AIR CONDITIONER NORMAL OPERATION [B] [C] 7 7 /, t/' _ _./" / ALTERNATE SOURCE AVAILABLE [D] 7 7 7 _,/_ / ' ./

TIME OF INSPECTION / 11'1(!) 1 () 1'J-io )~()i) llJM" EMERGENCY PHONE CHECK [E] / / _../'

NOTES: [A] -THE PRESENCE OF LEAKS, UNUSUAL ODORS, OR NOISES CONSTITUTES AN ABNORMAL CONDITION.

[B) - IF NORMAL CONDITIONS EXIST, ENTER A CHECK MARK; OTHERWISE NOTE EXISTING CONDITION.

[CJ - LOW HUMIDITY ALARM IS NOT AN ABNORMAL CONDITION.

[D] - 45P-MCC04/3 CB-23 IS CLOSED

[E)- VERIFY EMERGENCY PHONE LINE HAS A DIAL TONE. IF NOT, CONTACT THE FSM.

COMMENTS:

EA04AD3008-20-0 Rev. 1

THURS FRI

2 1 ()2 1

Original Signatures on File

-v

_./ ./ / /

/ / / ./ J../ ./ / / ....-"J / / / ,qor () 12 ~ !1t/o (76'-l~

/ /

APPROVED FOR USE/DATE:(

SAT SUN

2 1 2 1 2

v

/ ./ . ..,/ / ,/

~

/ / ./' v' V" / / v 7 v / ~ / 7 7

\Cfr\8: h~ o II I ~q-z.() jqg)

v' v v/

/1

Original Signatures on File

-

March 25, 2013 Page 1 of 1

=

Page 6: Round Sheet 12-30-13 to 01-05-14 · 2018-07-30 · Facility Site Operations and Infrastructure Seismic I Substation #7 I Duct I Fans Round Sheet Location: DAY SUN MON TUES WED BLDG

Facility Site Operations and Infrastructure RH Room 0/P and HVAC Panel Round Sheet

Location: DAY SUN MON TUES

COMPUTER STATIONS SHIFT 2 1 2 1 2

CMR, FSM DESK, LOCAL REVIEWER

411, WHB MECH EQUIP RM 200 & 208 FOT C/0

ITEM MIN NORM MAX

RH ROOM DPs.

OPERATING GALLERY PDD-01 "we ~l!L -t~O -. I MANIP. REPAIR RM. PDD-21A "we ;IS ":J'> -. \!"' FILTER GALLERY PDD-218 "we -or -:-o') ..... o~ . CASK LOADING RM. PDD-21C "we -.18 -1-0

' - .& CASK TRANSFER CELL PDD-21D "we -.1<1 :-Z:; -. '1 .} WASTE HOIST OPER RM PDD-21G 11

WC -.t..t -;o -. l} SERVICE ROOM PDD-21H "we -0.00 -0 .15 :I!/_ -;, 15"' - iC RH BAY PDD-21F "we 0.02 0.7 .tS" tl~"' ·" ~ t

HOT CELL PDT-52 "we -0.04 -1.1 :Sf -: 2--~ -, ~ HVAC CONTROL PANEL CHECKS

411-CP-051 -10 (803/805 AHU/EXH FANS) SAT [A] v / / 411 -CP-051-11 (804/806 AHU/EXH FANS) SAT [A) v / v 411 -CP-051-12 (878 A/B EXH FANS) SAT [A] a/" / // 411 -CP-058-17 (807 AHU FAN) SAT [A] ,/ ,/ v

NOTES: [A] - IF NORMAL CONDITIONS EXIST, ENTER A CHECK MARK; OTHERWISE NOTE EXISTING CONDITION.

COMMENTS:

EA04AD3008-23-0 Rev. 2

WED THURS FRI

1 2 1 2 1

Original Signatures on File

, 10 -' \ -. oct - ,'f - < . \ - I~ .

--: o; ,.. .. t)~ ·- 601 - "t.-0 ~ ' ( ~ -' 20 ,1.-~ ..... . ..,_, 1.r .... ,13

-:N ...-. I J - 13 -~~ - . ("( -. 14 • 10'( .. o~ ' 0$

-;s" -~ ; lt -, ).'1

....,.. v ..; .._ ,/ ./

- (/ v - J r/

APPROVED FOR USE/DATE:

SAT SUN

2 1 2 1 2

·-

'ff1_ ~- /() -.,/$ -, 15' -ffl_ -_Loq -,;;.o -I I 't 1Ji - 23.> ... L~ -. 13 -; Is - JL{ ,os . • 0 _"]_ --.t,o ·- 5<l

V" v ,/ v / V' , ./

Original Signatures on File -

March 19, 2013 Page 1 of 1

Page 7: Round Sheet 12-30-13 to 01-05-14 · 2018-07-30 · Facility Site Operations and Infrastructure Seismic I Substation #7 I Duct I Fans Round Sheet Location: DAY SUN MON TUES WED BLDG

Faci lity Site Operations and Infrastructure WHB CH Room D/P I HVAC I Air Dryer Round Sheet

Location: DAY SUN MON TUES WED

COMPUTER STATIONS SHIFT 2 1 2 •1 2,~ 1 ~

CMR, FSM DESK, LOCAL REVIEWER

411 , WHB MECH EQUIP RM 200 & 208 FOT C/0

ITEM MIN NORM MAX ·- _., ..... _!_;.,~ ···_ -- -;;:- ... -. - . WHB CH ROOM DPs

SHIELDED STORAGE RM PDD-026A "we -,/{) -:II .... o, .) \ CH AREA ROOM 103 PDD-0268 .. we -0.02 -771 -, o'7 ~. o, - II SITE GEN WASTE RM. PDD-026C "we -,IJ3 ,03 (J - . .0'\ EQUIP DECON RM . . PDD-026D "we -,a ·-;-ot3 ..-,e> I - 0'1 OVERPACK & REPAIR RM PDD-026E "we -0.04 -.~ - ,1 - .o'1 \.,..... CAGE LOADING ROOM PDD-006 "we , /.3 , I I - ~ I 1 .. -''l" AIRLOCK ROOM 107 PDD-007 "we -;~$ -;,~ -.o _~ -:-o~

HVAC CONTROL PANEL CHECKS

411-CP-052-15 (835/836 EXH FANS) SAT [A) /" _./' vi' .../

411-CP-063-16 (861/863 AHUS) SAT [A) ,/ / v -411-CP-052-14 (813/817 CH TRAIN) SAT [AI y / ./, -411-CP-052-13 (812/816 CH TRAIN) SAT [A) / / ./ ./

. WASTE HANDLING BUILDING AIR DRYER /l...

K-015 OUTLET (PSI) 95 135 TJJ Tr; T17 I) ()) ~D K-015 AQUADEX INDICATOR

BLUE I fAl ...y

K-015 AUTO SLOWDOWNS fTEST SAT [A]

K-015 DRYER MODE AMLOC crv \J I v I/ fAl , ; -t

NOTES: [A] . IF NORMAL CONDITIONS EXIST, ENTER A CHECK MARK; OTHERWISE NOTE EXISTING CONDITION. ~

COMMENTS: (0 ~hA_.Z? 1 ~~

EA04AD3008-26·0 Rev. 1

f I

Date: kj&>Ji-#f THURS FRI SAT SUN

2 1 A 1 Original Signatures on File

2 1 2 -~ 2

- . . --·- ft_:~ --cv, --.. ......-:;-...-- -· · C - ,_.. --- ... --- --:: •

"~', \ '1.,. - I\ /' . I { - i \ r .v..f -, oz...

- - 0~ - ,oq - d'l.. - ' l \ ,1,( . 2 '1 ·- .rJV. -. o-r

.. ,/ / t/ ./ v v' ./ ../

....... 1"\

!((JI {'£) <c.t ) (i)

-v .... v ~ Q

APPROVED FOR USE/DATE:

,. "' . -;. -./!) ·- .. I \ .-.

-,VI - t \ - ,!)). - D l-1 -.~ ;. • ~ er -, // ·- I 2. ~~ 2 3 -,tW - tro

v v ,_,/ ./ v! ./

I v ..,....

(l) {_/ ( 1) (J J ( I )

\l , ' v -~--~ ...

\.j v If) ~' 0) \ y '--"'

/\ Original Signatures on File -

March 22, 2013 Page 1 of 1